HSG Patient Info

HSG- Hysterosalpingogram

The Hysterosalpingogram (HSG) is a procedure performed by a physician or a practitioner at the radiology suite. The purpose of the procedure is to outline the contour of your uterus and check the condition of your fallopian tubes. During the procedure a special liquid is infused into your uterus. This fluid called contrast dye is visible by xray. Its progression through the uterus and the tubes can thus be tracked with fluoroscopy (xray of moving images). The procedure is quick, relatively painless and quite simple. The patient is able to watch the procedure and the results are available immediately.

Procedure Description

The procedure involves placing a speculum into the vagina for visualization of the cervix. The patient is positioned in stirrups similar to those used for a routine gynecological examination. A cleaning solution is used to clean the cervix and vagina. An instrument is then used to grasp the cervix to allow traction. A pinch may be felt at this point but this usually passes very quickly.
Next, a small catheter (tube) is inserted through the opening of the cervix. This catheter allows the contrast material to be injected into the uterine cavity. The speculum is then removed and the patient is moved out of the stirrups and positioned flat on the xray table. A radiologist is present to take the pictures.
As the contrast is slowly injected into the uterus, the image of the uterine cavity and fallopian tubes becomes visible on the monitor. Patients are encouraged to watch the monitor as the procedure is being done.
Once the contrast has been injected the radiologist will take a still Xray that demonstrates the HSG findings. Ideally, the contrast will appear to spill out of the ends of the fallopian tubes thus demonstrating tubal patency.
Patients with blocked tubes will either have tubes that do not fill with contrast, or tubes that fill but do not spill. Often dilated tubes will be demonstrated if the obstruction is at the fimbriated end of the fallopian tube (the part next to the ovaries).
After the still Xray has been completed the procedure is finished. And the patient can resume normal activities.

Risks

Cramping: The most common risk during an HSG procedure is cramping. The cramps are similar to menstrual cramps and subside very quickly. We advise you to take Motrin 800 mg or Advil Extra Strength approximately 30 min prior to the procedure. Mild cramping may continue for several hours following the procedure and is not a cause for alarm.
Spotting: Spotting is also common following an HSG. A pad is provided to protect clothing. The spotting may last a day or two and is not a cause for alarm. However, if frank bleeding occurs, the office should be notified immediately.
Dizziness and Nausea: On occasion, some patients experience a vasovagal reaction to the procedure. Some people are particularly prone to this reaction which includes hot flushes followed by dizziness, nausea, and potentially a blackout. When the reaction occurs is generally lasts only a few minutes and subsides without treatment. This reaction generally occurs during or shortly after the procedure. The patient is instructed to stay supine for 1015 minutes after the procedure and when rising, take care not to get up too quickly.
Infection: Infection to the uterus and tubes is theoretically possible but rarely seen. Because the contrast is injected through the uterus and tubes, bacteria can enter the reproductive tract. The female tract is quite capable of warding off infection. Because there is concern for a patient’s tubes in terms of infection and damage, some patients are given prophylactic antibiotics. Following the procedure, any disproportionate pain, fever, or unusual symptoms should be reported.
Radiation Exposure: The radiation exposure during a typical HSG is minimal and poses no known health risk. We do however try to insure that the procedure is not done during an early pregnancy because of the potential risk to the developing fetus. For this reason the procedure is scheduled in the first part of your cycle. In addition, a urine pregnancy test is performed by the technician prior to the HSG. If there is any possibility that you may be pregnant you must notify the technician prior to the procedure.
Allergies: Contrast allergies to iodine compounds are possible. Patients with a history of anaphylaxis are the most at risk group. Patient with a know allergy to iodine or shellfish should discuss their allergy with the practitioner and discuss the risk of the procedure and alternative tests.

Please discuss any concerns that you might have with the practitioner performing the test preferably in advance.

Scheduling the procedure

The HSG procedures are performed at the Tully Center in Stamford or at Advanced Radiology in Shelton. Please indicate to the scheduler which location is more convenient to you. The HSG is scheduled during the first half of you cycle (after day 5 and before day 12). This will insure that we maximize the information obtained from this test. The exact date of the exam will be determined when you call to schedule.

Findings

The HSG can reveal a variety of uterine and tubal abnormalities ranging from tubal blockage (and its location), uterine fibroids, uterine polyps and uterine scarring. The practitioner performing the HSG will usually be able to review the findings immediately following the procedure. However, a more detailed discussion of these findings along with recommendations for further treatment will occur at the time of follow up appointment.

Preparing for an Appointment

The HSG is generally performed within two weeks of the onset of menses and following the heavy flow. When you call the office to announce the onset of your cycle the HSG will be scheduled along with other diagnostic tests. It is recommended that you have had a small lunch and have taken 600 to 800 mg of ibuprofen one hour before the procedure. If you cannot take ibuprofen, then 500 mg of Tylenol would be helpful to reduce cramping during the procedure.